Is it reasonable to start Ozempic (semaglutide) for weight management?

From the Guidelines

Starting Ozempic (semaglutide) for weight management can be reasonable for certain individuals, particularly those with obesity (BMI ≥30) or overweight (BMI ≥27) with at least one weight-related comorbidity such as hypertension, type 2 diabetes, or dyslipidemia, as recommended by the American Gastroenterological Association 1. The decision to start Ozempic should be based on a thorough medical evaluation, considering the patient's clinical profile, comorbidities, preferences, costs, and access to therapy.

• The typical starting dose for Ozempic is 0.25 mg injected subcutaneously once weekly for the first month, then increased to 0.5 mg weekly, with potential further increases to 1 mg weekly if needed, as indicated in the study by 1.
• Semaglutide works by mimicking GLP-1, a hormone that regulates appetite and food intake, helping you feel fuller longer and reducing overall calorie consumption.
• It should be used alongside lifestyle modifications including diet and exercise, not as a replacement.
• Before starting, patients should be evaluated for contraindications such as personal or family history of medullary thyroid carcinoma, Multiple Endocrine Neoplasia syndrome type 2, or pancreatitis, as noted in the study by 1.
• Insurance coverage varies significantly, and without coverage, the medication can be expensive.
• Recent guidelines from the European Heart Journal suggest that pharmacological treatment with GLP-1 receptor agonists, such as semaglutide, may be considered for further weight reduction in patients with chronic coronary syndromes 1.
• The SELECT trial showed a significant reduction in the incidence of cardiovascular death, MI, or stroke in patients with pre-existing CVD who were overweight or obese, but without diabetes, treated with weekly subcutaneous semaglutide 1.

From the Research

Reasonability of Starting Ozempic for Weight Management

The decision to start Ozempic (semaglutide) for weight management can be informed by several studies that have investigated its efficacy and safety in adults with overweight or obesity.

• Efficacy: Studies have shown that semaglutide is effective for weight loss in adults with overweight or obesity. For example, a study published in The New England Journal of Medicine found that once-weekly subcutaneous semaglutide at a dose of 2.4 mg resulted in a mean change in body weight from baseline to week 68 of -14.9% compared to -2.4% with placebo 2. Another study published in JAMA found that once-weekly subcutaneous semaglutide compared to once-daily subcutaneous liraglutide resulted in significantly greater weight loss at 68 weeks 3.
• Safety: The safety profile of semaglutide has been evaluated in several studies. Common adverse events include nausea and diarrhea, which are typically transient and mild-to-moderate in severity 2, 3, 4. A study published in The Lancet found that all semaglutide doses were generally well tolerated over 52 weeks, with no new safety concerns 4.
• Comparison to Other Treatments: Semaglutide has been compared to other treatments for weight loss, including liraglutide. A study published in JAMA found that once-weekly subcutaneous semaglutide compared to once-daily subcutaneous liraglutide resulted in significantly greater weight loss at 68 weeks 3. Another study published in The Lancet found that semaglutide was well tolerated and showed clinically relevant weight loss compared to placebo at all doses 4.
• Regulatory Approval: Semaglutide is approved by the US Food and Drug Administration (FDA) for chronic weight management in patients with a body mass index (BMI) of 27 kg/m2 or greater and at least one weight-related condition, or in patients with a BMI of 30 kg/m2 or greater 5.
• Clinical Considerations: The decision to start Ozempic for weight management should be made on a case-by-case basis, taking into account the individual's medical history, current health status, and other factors. Healthcare providers should counsel patients on the potential benefits and risks of semaglutide and monitor them closely for adverse events 5, 2, 3, 4, 6.